CHW Nakku takes care of a pregnant mother and refers a child to Kitebi Health Center for suspected yellow fever.

Our direct operations in Uganda continued to register strong performance in Q1, with improved or stable results across all KPIs. Under-five (U5) treatments and positive diagnoses were 53% above target in Q1 and under-one (U1) treatments and diagnoses were 63% above target. This performance is attributed to continued emphasis on targeting sick children, improved performance management among community health workers (CHWs), and a stronger supply chain of essential medicines at both the CHW and branch level.

On-time postnatal care (PNC) visits jumped from 61% in Q4 2019 to 70% in Q1 2020, though it is still slightly below the 75% target. A key factor driving this achievement is that all upcoming expected delivery dates and missed PNCs are now shared with the branch teams at the beginning of each month to drive timely CHW follow-ups with new mothers and pregnant women nearing their delivery dates. Meanwhile, the percentage of women delivering in a facility was 93% in Q1, above the target of 85%. This is attributed to continued follow-ups by CHWs to counsel pregnant women and prepare them for facility delivery.

A total of 80% of defaulters completed necessary immunizations in Q1, above the target of 60%. This performance is attributed to regular immunization-related support to CHWs and branch teams during the in-service training and continued workflow optimization. The reasons for non-completion of referrals among defaulters remain lack of transport, lack of vaccines at referral sites, and concerns about side effects. 

We trained 300 CHWs in family planning in Q1 instead of the expected 600 CHWs. This was to prioritize the rollout of the new version of our Smart Health app and hold Sayana Press practicum and refresher training for CHWs who missed them in Q4 when stocks were limited. The new version of the Smart Health app will resolve many existing limitations, including delayed syncing, slowness, and inability to remove families who had moved away. All family planning trainings were suspended mid-March due to COVID-19. Our referral numbers are lower than we’d prefer for longer-term and permanent methods, and we are working to secure lists of referral clinics from potential partners to improve those efforts.

BRAC’s performance was below target across most KPIs in Q1 due to the low number of active CHWs, with only 3,195 against a target of 3,500; training of new CHWs had been planned for March but delayed due to COVID-19. The low rate of CHW activity is due in part to a low supervisor–to–CHW ratio in some branches, though BRAC is working to recruit new supervisors remotely. Synchronization challenges, app load failure, and damaged phones also contributed to the low number of active CHWs and related underperformance across KPIs. BRAC anticipates that the Smart Health app upgrade in Q2 will alleviate some of these functionality challenges to improve CHW activity moving forward. In April 2020, BRAC will start to distribute performance-linked incentives to all CHWs, which is expected to drive increased CHW activity.